198600539-9-12-2023-28-AS-LHIS-CVPKN2-20230915080224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/12/2023
Date Signed: 09/12/2023 01:07:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/07/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230907120709

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 137	DATE:	09/12/2023
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Christina Vasquez, Staff		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff did not safeguard residents’ personal belongings.
Resident was threatened by another resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint visit to investigate the above allegations. The purpose of the visit was explained to staff Christina vasquez. Administrator Andrew De Vera arrived shortly after.

The investigation consisted of the following: A physical plant tour of common areas, and three (3) rooms was conducted. Staff (S1-S4) and residents (R1-R11) were interviewed. Resident (R12) refused to be interviewed. LIC 500 Personnel Report, resident roster, resident (R1 & R12's) files were reviewed. Identification and Emergency Information, Appraisal/Needs and Servives Plan, Resident Personal Property and Valuables, Personal Property Procedures, and Resident Theft and Loss Record were obtained pertaining to R1. A copy of resident (R12's) Appraisal/Needs and Servives Plan was reviewed and obtained as well.

***Report narrative continues next page.****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230907120709

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 09/12/2023

NARRATIVE

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Staff did not safeguard residents’ personal belongings. It is alleged that in the last several weeks resident (R1’s) personal items have been damaged and/or stolen i.e., watch was cut in half, and a pair of shoe insoles, and cup were stolen from the bedroom.Based on record review, the alleged items damaged and/or stolen are not listed on R1’s Personal Inventory list. Per Administrator, Andrew De-Vera residents are told when they first move in that when they buy new items to inform staff. Mr. De-Vera stated that big products are usually reported to staff and added to the inventory list, but smaller items are not. Resident (R1's) roommate, R2 was interviewed and stated that R1 put things somewhere in the room, forgets where they placed them, and later finds the items. In regards to the missing cup, R1 stated that the cup was found in their backpack. Resident (R1 & R2) reported that housekeeping staff open the sliding door that leads to the balcony, and residents could easily steal things from their room. A total of 11 residents were interviewed. Four (4) out of 11 reported they have had belongings stolen. Housekeeper/staff (S3), stated R1 misplaces personal belongings and has not reported the items missing. Per S3, when the room is being cleaned the sliding door is opened for ventilation, and closed when housekeeping duties are done. Per staff interviews, each resident has a latch in the closet door they can lock and keep valuables safeguarded. Residents have a key to their room. However, based on physical plant observation, some residents keep their door opened and/or unlocked. NOTE: R1's room is located on the 2nd floor. There is insufficient evidence to corroborate the allegation.

Allegation: Resident was threatened by another resident while in care. It is alleged that two (2) next door residents threatened resident (R1) by saying they were going to break the resident’s neck. A total of four (4) staff were interviewed. According to information gathered, R1 did not report the alleged incident to staff. Staff stated R1's next door residents do not have aggressive behaviors and there have been no reports of threatening behavior towards R1; with the exception of a report last week stating that a resident (name unknown) verbally told resident (R1) f**k you. This type of incident is not generally documented as an incident, nor is law enforcement called. However, staff stated that another resident (R12) nearby has frequent verbal aggressive behaviors; curses and says racial slurs at staff and residents. It is unknown if the alleged threats towards R1 were made by R12. LPA attempted to interview R12, but the resident refused. Staff practice is to try to keep certain residents from others if they suspect the resident's behavior will lead to aggressive actions or trigger other residents. A total of 11 residents were interviewed, of which 5 residents stated that they have been threatened by other residents. Residents reported that arguments between residents is commonplace at this facility. Resident (R1's) roommate has heard R12 curse at resident (R1), but has not heard threats that may pose a health and safety risk to the resident. The residents at this facility are mentally disabled, and many have disorganized though process with history of hallucinations and paranoia. There insufficient evidence to prove the alleged allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.
Exit interview was conducted with Christina Vasquez. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC9099 (FAS) - (06/04)

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